Provider Demographics
NPI:1932420148
Name:LANDA, ROSS (OTR/L)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:
Last Name:LANDA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5924
Mailing Address - Country:US
Mailing Address - Phone:516-680-7447
Mailing Address - Fax:
Practice Address - Street 1:3848 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5924
Practice Address - Country:US
Practice Address - Phone:516-680-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011337-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist